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Kamis, 17 April 2014

Lawsuit in California With United Healthcare-Medicare Advantage Plans in California Have No Urgent Care Centers In Network-Higher Co-Pays Result

The company is so large anymore with so many subsidiaries I guess keeping on top of business analytics, contracts and policies is getting to be a chore. This is not a huge lawsuit here but the complaint is for false advertising basically with showing commercials for Secure Horizons promising competitive service and this patient found out there were no urgent care centers in network in California. A higher co-pay of $50.00 instead of $30.00 applies.

United pulled out of California with individual policies at the end of 2013 and basically what’s left here is employer insurance along with Medicare Advantage and of course Tri-Care. Maybe they are going to build urgent care centers here too like they are doing elsewhere?

Part of the case here is to also stop representing that plan participants can receive urgent care for #30.00. BD

Law360, Washington (March 31, 2014, 7:48 PM ET) -- United Healthcare Services Inc. was hit with a putative class action in California court Friday, accusing it of misrepresenting in its advertising the reach of the health care provider network available to beneficiaries of its Medicare Advantage plans in California. The managed health care company misleadingly advertises that its Medicare Advantage plans offer one of the largest available networks of local doctors, hospitals and clinics, while actually failing to offer access to any in-network urgent care clinic in California under those plans, plaintiff Edward J. Roberts alleges.

As a result, plan beneficiaries have no choice but to incur $50 co-payments for each urgent care clinic visit they need as out-of-network claims, instead of the $30 they would pay for an in-network visit, according to the complaint.

Eventually, a United Healthcare supervisor informed him that the plan’s network included no urgent care clinics in the state at all and he was forced to pay a $50 dollar co-pay when he later needed urgent care at the recommended clinic, the complaint alleges.